A municipal hospital system’s Epic EMR install has gone dramatically south over the past two years, with four top officials being forced out and a budget which has more than doubled.

In early 2013, New York City-based Health and Hospitals Corp. announced that it had signed a $302 million EMR contract with Epic. The system said that it planned to implement the Epic EMR at 11 HHC hospitals, four long term care facilities, six diagnostic treatment centers and more than 70 community-based clinics.

The 15-year contract, which was set to be covered by federal funding, was supposed to cover everything from soup to nuts, including software and database licenses, professional services, testing and technical training, software maintenance, and database support and upgrades.

Fast forward to the present, and the project has plunged into crisis. The budget has expanded to $764 million, and HHC’s CTO, CIO, the CIO’s interim deputy and the project’s head of training have been given the axe amidst charges of improper billing. Seven consultants — earning between $150 and $185 an hour — have also been kicked off of the payroll.

With HHC missing so many top leaders, the system has brought in a consulting firm to stabilize the Epic effort. Washington, DC-based Clinovations, which brought in an interim CMIO, CIO and other top managers to HHC, now has a $4 million, 15-month contract to provide project management.

The Epic launch date for the first two hospitals in the network was originally set for November 2014 but has been moved up to April 2016, according to the New York Post. HHC leaders say that the full Epic launch should take place in 2018 if all now goes as planned. The final price tag for the system could end up being as high as $1.4 billion, the newspaper reports.

So how did the massive Epic install effort go astray? According to an audit by the city’s Technology Development Corp., the project has been horribly mismanaged. “At one point, there were 14 project managers — but there was no leadership,” the audit report said.

The HHC consultants didn’t help much either, according to an employee who spoke to the Post. The employee said that the consultants racked up travel, hotels and other expenses to train their own employees before they began training HHC staff.

HHC is now telling the public that things will be much better going forward. Spokeswoman Ana Marengo said that the chain has adopted a new oversight and governance structure that will prevent the implementation from falling apart again.”We terminated consultants, appointed new leadership, and adopted new timekeeping tools that will help strengthen the management of this project,” Marengo told the newspaper.

What I’d like to know is just what items in the budget expanded so much that a $300-odd million all-in contract turned into a $1B+ debacle. While nobody in the Post articles has suggested that Epic is at fault in any of this, it seems to me that it’s worth investigating whether the vendor managed to jack up its fees beyond the scope of the initial agreement. For example, if HHC was forced to pay for more Epic support than it had originally expected it wouldn’t come cheap. Then again, maybe the extra costs mostly come from paying for people with Epic experience. Epic has driven up the price of these people by not opening up the Epic certification opportunities.

On the surface, though, this appears to be a high-profile example of a very challenging IT project that went bad in a hurry. And the fact that city politics are part of the mix can’t have been helpful. What happened to HHC could conceivably happen to private health systems, but the massive budget overrun and billing questions have government stamped all over them. Regardless, for New York City patients’ sake I hope HHC gets the implementation right from here on in.

Not settled with simply being the dominant device on which clinical data applications are hosted, Apple made another step towards becoming an even more ubiquitous presence at healthcare organizations last week when it launched ResearchKit.

ResearchKit is a platform that allows healthcare organizations to host apps that will get people to participate in clinical trials. During an event for the press, the company announced a few initial partnerships with major healthcare provider organizations to use ResearchKit, including Icahn School of Medicine at Mount Sinai, Penn Medicine, Dana-Farber Cancer Institute, Massachusetts General Hospital, Stanford Hospital, and more.

ResearchKit builds off HealthKit, which was a health platform Apple launched last year that aimed to connect personally-generated health data and clinical data. Since HealthKit’s launch, many notable healthcare organizations, including Stanford Medicine, Cleveland Clinic, and EHR vendors like Epic, have all partnered with Apple to work in their own patient-generated data applications.

The Cupertino, Calif.-based company is part of a wider movement in the industry to bring patient-generated health data (PGHD), from various portals and monitoring devices, into clinical data applications like the electronic medical record (EMR). The Office of the National Coordinator for Health IT (ONC), in its proposed rule for Stage 3 of meaningful use, made integrating PGHD into the EHR a requirement for eligible hospitals and providers.

Of course, this integration is easier said than done. Healthcare Informatics Senior Editor Gabriel Perna spoke with Rob Faix, principal advisor at the Naperville, Ill.-based consulting firm, Impact Advisors on the most recent edition of the Healthcare Informatics podcast. Faix discusses the challenges of bringing together patient and clinical data; why Apple has taken the lead in this category with many prominent healthcare organizations; and how ResearchKit can be a game changer.

“Integrating this data will be a significant challenge but I think it’s one that hardware device vendors, software developers, and EMR vendors are up for…it’s the next big opportunity,” Faix says. “

Faix talks about how this integration may happen. He predicts there will be a staging process, where PGHD is graded and reviewed. “Context will be important. The software and EMR vendors and the clinical community are really going have to think about that as we integrate PGHD into the EMR,” he says.

Sifting through a potential avalanche of data will present itself as a challenge, as will having to deal with potential issues of liability. “I have information in front of me that I chose to accept or discard, and therefore, it could be tied back to an adverse event,” Faix says.

Epic’s EHR has grown exponentially over the past few years and now dominates medium and large practices, as well as many of the major health systems across the country. Epic already provides a host of integrative features for providers and patients including EpicCare Link, Bedside, Care Everywhere, myChart (patient-controlled portal), Haiku (mobile and secure physician access to patient records and imaging), and Lucy (a freestanding patient personal health record).

With the ubiquity of Epic in the healthcare marketplace, there has been a lot of buzz about a planned addition to that suite – the Epic App Exchange. Although details haven’t been released, descriptions of the Epic App Exchange liken it to the Apple App Store. Epic will provide the instructions for creating and integrating apps with Epic’s network infrastructure. This would potentially open Epic to app developers to produce innovative solutions for Epic customers to improve patient care.

The news broke a few weeks ago at a Wisconsin Innovation Network by Mark Bakken, co-founder and former CEO of Nordic Consulting and founder of HealthX Ventures, where the Epic App Exchange was touted to be the next big thing that would “open the floodgates” for app developers and “cement [Epic’s] long-term legacy.”

For some that have followed Epic over the past 2 years, this may conjure memories of the release of Open.Epic with hopes that it would lead to greater interoperability. However, Open.Epic only allowed developers to input data from patient wearables and sensors passively into Epic and the API did not allow free exchange in and out of the Epic system. The recent Epic App Exchange announcement has been met with tempered hope and excitement, as the ultimate utility depends on as-yet unreleased details.

The question becomes how “open” will this Epic App Exchange be and will any and all developers have access to the API. At this time, it is impossible to know whether the Epic App Exchange will only be an exchange of apps for its closed-system customers, or whether it will be open to developers and innovators to create products on top of the Epic system, thus propelling the country towards greater national interoperability.

The Epic App Exchange comes prior to the announcement of the final contract for the Defense Healthcare Management Systems Modernization (DHMSM) and Department of Defense. The DHMSM program has a mission to “acquire, test, deliver, and successfully transition to a state-of-the-market electronic health record (EHR) system” for it’s 9.6 million beneficiaries and 153,000 personnel across 1,200+ worldwide locations. Key features to incorporate include a “patient-centric system” that is “flexible and open” and “enable full patient engagement in their health.” The report by DHMSM also emphasized the importance of interoperability and “collaborative partnerships to advance national interoperability.” There are 4 teams being considered for the DHMSM and DoD contract worth upwards of $11 billion over a few years. One of the 4 teams includes Epic partnered with IBM.

In order to move healthcare forward and focus on value and quality in medicine, there is a tremendous need for national interoperability of electronic health records. To make this dream a reality, it will take some of the major players in healthcare IT, like Epic Systems, to allow developers to create innovative solutions on their robust network infrastructures. We hope that the Epic App Exchange is a step in the right direction, but the devil lies in the details and we don’t have those details yet.

Behavioral health EHR adoption is on the radar of health IT developers already well position in acute and ambulatory settings. For behavioral health organizations and providers, the challenge of EHR integration centers of the difference in provider workflows and their use of health IT to document a patient’s care.

As value-based care programs extend the range of the care continuum, the ability to move a patient’s health data between primary and specialty providers becomes a necessity. The rise of accountable care, however, may be responsible for eroding differences between care settings and providers.

“As accountable care and the new healthcare environment that move forward in evolves, there will be less difference because one of the big things in behavioral health is that it is very much a team environment so that you have folks from all different specialties participating along with the patient,” says Melinda Wagner, General Manager of Behavioral Health for Cerner.

That being said, primary care and behavioral health are currently distinctly different animals. As health IT developers from traditional care settings to behavior health environments, they must come to appreciate what makes the two distinct.

“As we integrate mental and physical health together, there will be a lot of great lessons more learned by the physical side,” Wagner explains. “Your workflows are perhaps a little bit different, and the care planning coordination are definitely much different.”

For Cerner, this learning process has relied heavily on feedback from providers from both environments. ” We acquired a community solution a couple years back and that really thrust us into the environment quickly, so we have been gleaning information from the community clients as well as existing Cerner clientele who were primarily acute clients with behavioral health access about what was missing,” Wagner reveals.

“They did have their own system,” continues Wagner, “so they had been automated for some time and mature in their thinking about how IT supports their overall workflows and patient care. We have worked with them for a couple years in looking at how our Cerner functionality would fit their needs as well as our overall vision for where we’re taking our solution.”

While the transition from one electronic documentation platform to another presents challenges, the greatest test for behavioral health EHR adoption remains interoperability with the EHR technology of other providers involved in a patient’s healthcare experience.

“It is the patient’s right to be able to expect that from healthcare and IT providers — that we will find ways to interoperate, that there won’t be one single system ever,” says Wagner. “That’s a driving force behind why Cerner got into behavioral health. Between interoperability and population health, we recognize to provide care for the whole person that behavioral health is integral to that.”

And the mental health environment likewise brings with it privacy concerns.

“We’re now trying to figure out how to make that compliant but still be able to share information,” Wagner observes. “We need to make sure that we protect the rights of those folks on the mental health side while also protecting their right to full and safe care by sharing information that needs to be given to other providers responsible for coordinating overall care.”

With patient’s road to recovery now taking a variety of routes, his health data must demonstrate the capacity for moving where it is needed.

I came across this tweet and it made me stop and realize how important the selection and more important the implementation of your EHR will be for your organization. In many areas there’s already a nurse shortage, so it would become even more of an issue if your hospital comes to be known as the hospital with the cumbersome EHR.

Here’s some insight into the survey results from the article linked above:

79% of job seeking registered nurses reported that the reputation of the hospital’s EHR system is a top three consideration in their choice of where they will work. Nurses in the 22 largest metropolitan statistical areas are most satisfied with the usability of Cerner, McKesson, NextGen and Epic Systems. Those EHRs receiving the lowest satisfaction scores by nurses include Meditech, Allscripts, eClinicalWorks and HCare.

The article did also quote someone as saying that a well done EHR implementation can be a recruiting benefit. So, like most things it’s a double edge sword. A great EHR can be a benefit to you when recruiting nurses to your organization, but a poorly done, complex EHR could drive nurses away.

I’m pretty sure this side affect wasn’t discussed when evaluating how to implement the EHR and what kind of resources to commit to ensuring a successful and well done EHR implementation. They’re paying the price now.

There's little question that Cerner and Epic are the giants in the EHR field. Epic is dominant not only in the scope of its market share but also in the depth of its client base. Mayo Clinic announced last month that it would be abandoning its three current EHR systems in favor of a new contract with Epic, which will now be the healthcare icon's sole EHR provider and strategic partner. Jilted in the deal were GE and Cerner, who were the providers of Mayo's current systems—although if you tallied the figures when Cerner acquired Siemens' EHR unit for $1.3 billion, it still had the largest US market share of any vendor, with 1,132 acute care hospitals.

Epic is still on top, but only by a percentage point (eClinicalworks is close on its heels). And as you might expect, Epic's client base skews heavily towards larger practices, dominating the 41+ practice market at 54%. On the lower end of the scale (1 - 3), Epic, eClinicalworks, Allscripts and Practice Fusion are all within a percentage point or two of one another.

Cerner, notably, is way down the list across the board in the physician practice world, taking just 3.5% of the overall market. So is athenahealth, at 3.3% overall and just 0.4% and 0.8% in the 26 to 40 and 41 and up segments. This tallies with the cloud-based vendor's ongoing investments in the inpatient market, however: In January, the cloud-based provider purchased start-up RazorInsights to move into the 50-bed and under sector, a niche that accounts for one-third of all hospitals in the US; and last week the company announced that it has purchased WebOMR, Beth Israel Deaconess' cloud-based, stage 2-certified EHR, for commercial development in the hospital setting.

Epic Systems Corp. is about to launch its own app store — much like Apple’s App Store — opening the door for outside companies to create applications that will work with Epic’s widely used electronic health records systems.

Mark Bakken, co-founder and former chief executive of Nordic Consulting, the largest consultant firm working with customers of Verona-based Epic, stirred up excitement about the plan Tuesday at a luncheon meeting of the Wisconsin Innovation Network.

Bakken said the app store will launch in a few weeks and it will “open the floodgates” for all sorts of companies to develop and market their apps, especially those in the Madison area populated by former Epic employees.

“We think Epic is big now? This will cement their long-term legacy. It’s exactly the right thing to do,” Bakken said later in an interview.

Epic spokesman Shawn Kiesau confirmed the plans but could not provide immediate details. It will be called the App Exchange, he said.

Bakken said Epic’s App Exchange will work similarly to Apple’s App Store.

“Let’s say you want to create an app for the iPhone. Apple has automated that online. As long as you play by all the rules, they’ll publish it,” said Bakken. Epic will be “publishing a road map about how to work with Epic,” he said.

Bakken said there are all sorts of potential uses for the Epic App Exchange, both for health care organizations and for consumers. He said he expects the first apps to come from Epic’s customers, so that one health care organization can offer other hospitals and clinics the specialized programs it has developed to work along with Epic’s software.

“Once they officially launch this, then it’ll be very, very easy. It will really open the floodgates for anyone that knows Epic to really get their product on the market quickly and in front of Epic’s customers. So the distribution channel is huge,” Bakken said.

Politically, he said, the App Exchange should squelch some of the criticism Epic has drawn from those who say its system is too closed, and that it is too hard to share medical records between health care groups that use Epic’s systems and those that don’t.

That may be particularly important as the U.S. Defense Department considers which team should receive a contract worth up to $11 billion over five years to install an electronic health records system for the U.S. military. Epic and IBM have submitted a joint application for that contract, which is expected to be awarded later this year.

Bakken’s comments about Epic’s App Exchange came as the Madison tech entrepreneur spelled out plans for HealthX Ventures, a fund Bakken is forming to invest in very early-stage health information technology companies, many of which are being created in the Madison area by former Epic employees.

Currently at $5 million, Bakken hopes to raise $10 million to $20 million for the fund. He said Nordic’s clients include some of Epic’s most prestigious customers, such as Kaiser Permanente, Johns Hopkins and the M.D. Anderson Cancer Center at the University of Texas, and he plans to introduce some of the local start-ups to them.

A goal of HealthX Ventures is “helping startups get to the next level,” said Bakken. If they can snag $1 million in revenue within a year, other venture firms will want to invest, he said.

“And hopefully, we have five more Epics,” Bakken said.

Epic has about 8,000 employees and its preliminary 2014 revenues were $1.8 billion, spokesman Kiesau said.

About 135 people attended the luncheon at the Sheraton Madison Hotel held by Wisconsin Innovation Network, a tech-oriented group that’s part of the Wisconsin Technology Council. Among them was Niko Skievaski, co-founder of Redox, a new business aimed at helping health care applications connect with electronic health records companies such as Epic.

Redox grew out of 100health, initially meant to incubate health IT startups. “We were missing the capital and therefore couldn’t get them going fast enough. That’s why we focused on Redox,” Skievaski said.

He said Bakken was Redox’s lead investor in a $350,000 funding round in December. “He sat other investors down and said, ‘Guys, this is a good deal,’” Skievaski said. He said Bakken’s HealthX fund is “exactly what Madison needs right now.”

The SHC MyHealth mobile app is designed to make it quick and simple for patients to manage their care right from their iPhones, including:

• Make appointments

• Get test results – your lab results are automatically made available in the palm of your hand

• Communicate with your care team through a secure messaging system where your information is always kept confidential

• Have a video visit with your doctor through the new ClickWell Care clinic which gives you the convenient option of a “virtual” appointment

• Manage your prescriptions and medications

• View your health summary

• Access and pay your bills

• Share your vitals with your doctor via HealthKit integration

Secure Messaging

With the new MyHealth app, patients can communicate directly with their care team through a confidential and secure messaging system. In addition, the app automatically syncs with wearable and wireless products, allowing patients to take vital signs at home or on the go. That data is automatically and securely added to the patient’s chart in Epic for their physician to review remotely.

“The SHC MyHealth app allows patients to connect their lives with their health care,” said Pravene Nath, MD, Chief Information Officer, Stanford Health Care. “By integrating with companies like Withings, our physicians have access to meaningful patient data right in Epic, without having to ask the patient come in for an appointment. We believe this is the future of how care will be delivered for many types of chronic conditions.”

The free SHC MyHealth app can be downloaded from the Apple App Store. It is available for current Stanford Health Care patients with a MyHealth account. Existing SHC patients that do not have a MyHealth account can sign up at myhealth.stanfordhealthcare.org.

Let me be candid here: I’m not too pleased with the progress of Epic as the hospital system of choice. Experience tells me that once a vendor becomes the default choice, seemingly due as much to C-suite peer pressure as technical merit, vendors get lazy and worse, extremely arrogant.

I admit most of us would be blinded by the magnitude of Epic’s success. According to chief administrative office Stephen Dickman, who spoke at a recent business luncheon in Madison, Epic’s stats include the following:

* It had 260 customers last year, and expects to add another 30 large customers this year

* It serves hospitals and clinics treating 33 percent to 44 percent of the U.S. population

* It has 5,225 employees and expects to add 1,000 this year

* It expects to have generated $1.2 billion in 2011 revenues

* It has only five sales people on staff (!)

Sure, these numbers are very impressive. But that doesn’t excuse Epic’s imperial attitude, or CEO Judith Faulkner’s contention that hospitals should only worry about interoperating with her company’s products. Look, Ms. Faulkner: I’m sure you’re bright, but I’m pretty sure you’re no Steve Jobs. You may be taking over the hospital EMR business, but you’re not reinventing it.

In my experience, users uniformly say that Epic’s interface is all but broken, that it’s hard to adapt and in some cases, that the 20-something young geniuses the company sends to install and service its systems aren’t particularly deferential. (If you want to hear a particularly galling tale — downright terrifying, if true — check out the tale of one engagement in which Epic staffers seemingly tried to get a hospital CIO fired.)

Meanwhile, if Epic leaders ever gave a damn about building great products, they don’t have a lot of incentive to do that now. Yes, they face well-financed competition from Cerner and Meditech and GE, but if they only have five sales people on board, they must assume they can beat those folks with one hand tied behind their back. At this point, in other words, competition isn’t enough reason to keep improving their product.

I guess the bottom line here is that I instinctively distrust any company that seems too secure at the top, especially if they’re not known for being especially likeable or having a superior product. Isn’t anyone going to show up and challenge them for the throne?

Google is a key contender – part of the PwC team – bidding on the massive 10-year federal contract to build an electronic health record system for the Department of Defense. PwC announced the collaboration with Google Thursday.

Google had been part of the team from the start, Dan Garrett, PwC's health IT leader, told Healthcare IT News.

"They were part of our submission in our original proposal," he said. "Since the proposal, we've also cemented a broader relationship between the two firms. And, we thought it was appropriate now to make the rest of the world aware of the submission that we had made."

"Google provides us with another whole layer of options from an infrastructure perspective." Garrett said. "You have everything from work management, storage, search engines, security, cloud – a whole level of infrastructure that we can pick from as the industry changes and innovation continues to come into the space."

Besides Google, the main players on the PwC team include General Dynamics Information Technology, DSS Inc. and Medsphere, whose commercial OpenVista EHR, an open source offering, was derived from the VistA-EHR, built by the Department of Veterans Affairs.

The other three teams that submitted bids are:

IBM and Epic

Computer Sciences Corp., partnered with HP and Allscripts

Cerner, Leidos, Accenture Federal and Intermountain Healthcare

Formally named the Department of Defense Healthcare Management Systems Modernization Electronic Health Record contract – DHMSM, for short, the DoD award could pay as much as $11.3 billion over 10 years. DoD is expected to award the contact this June.

As the clock ticks toward the anticipated verdict, the contenders have released more information on their bids. Epic, typically silent about any of its doings, last week joined its partner, IBM, to reveal it had assembled a team of advisors from some of the most recognizable health system names in healthcare, among them Kaiser Permanente and Partners HealthCare.

The PwC proposal is called the Defense Operational Readiness Health System. Garrett refers to it as DORHS.

PwC's interest in Google is not limited to the DoD contract. PWC and Google also recently forged a business relationship in which they will team up to help companies use the cloud and build trust in it.

“Google is known for its expertise in innovative, secure and open technologies, and the power of Internet scale, Scott McIntyre, PwC’s clobal and U.S. public sector leader, said in a statement. “Google can assist us in delivering a cost-effective and efficient solution to serve the healthcare needs of our military.”

“Our solution is engineered to provide flexibility, cost effectiveness and a platform that will stand the test of time, and does not rely on unproven technologies or proprietary computing platforms,” said Garrett. "Consistent quality is what we were looking for, true open systems, true interoperability and true open source systems."

DORHS’ flexibility, he added, would help prevent the federal government from being locked into a single technology, avoiding “vendor lock” and “innovation lag” which can occur with proprietary EHR and technology companies.

"Google is a great example of how we're going to prevent that," Garrett said. "With Google on our team, the DoD will be able to tap in to the latest and greatest infrastructure innovation for the duration of those 10 years,."

A number of Epic Systems products have achieved top marks in the annual Best of KLAS health IT and EHR rankings, including best overall physician practice vendor and best overall software suite in addition to other awards for acute care, ambulatory care, health information exchange (HIE) and patient portals. The recognition signals a return to dominance for the health IT giant, which temporarily lost its top title to athenahealth in 2013.

“We are honored to be able to continue to work with talented healthcare providers to create the annual Best in KLAS report. Their feedback is beneficial as vendors strive for excellence,” said Adam Gale, CEO and president of KLAS Research in a news release announcing another winner, Phytel, which was named the top population heath management vendor. “We also look forward to expanding our global research initiative to evaluate additional products/services that impact both provider and vendor success.”

Other familiar names featured frequently in the latest report, including Impact Advisors, winner of the overall IT services firm category, Cerner Corporation for best small ambulatory EHR, and athenahealth for small and mid-sized practice management. Epic, however, snagged the ribbon for large ambulatory practice management.

Accenture Health may be getting a few more phone calls in the next few months after being named best ICD-10 consulting firm, while Optum’s computer assisted coding (CAC) expertise won the category for the in-demand technology. For clinical documentation improvement (CDI), another critical ICD-10 competency, KLAS awarded first prize to Navigant.

Overall, Epic received eleven recognitions from the independent research company, which indicates how deeply and widely the company has been able to integrate itself into the healthcare industry’s IT needs. In contrast, Cerner received three nods and athenahealth bagged two, while McKesson and MEDITECH had one apiece. Last year, athenahealth had five honors to its name, with Chairman and CEO Jonathan Bush claiming that his company’s victory over Epic for ultimate prize was a triumph of “nimble, innovative models” over the “old guard of HIT leaders.”

Putting aside Epic’s runaway dominance – and athenahealth’s slip from the spotlight this year – Bush may have been correct in saying that new contenders are challenging the big names that seemed so solidified in the early days of the EHR Incentive Programs. The large number and diversity of winners shows that the marketplace continues to be fragmented, giving new companies a chance to offer the intuitive, user-friendly, feature-rich EHRs that healthcare organizations are clambering for.

With EHR replacement still a very strong force in the marketplace, vendors have a strong incentive to claw their way past their competitors onto EHR ranking lists that give them visibility and credibility in an environment of weary mistrust.

“We are all part of a community of care,” Gale said of the 2013 winners list. “From the vendors that provide services and advance healthcare technology, to KLAS, who produces insights on vendor performance, to the providers who administer care, our joint efforts can make a difference in the lives of the patients.”

“To the healthcare providers, your effort to be heard and counted is critical. It is your voice, amplified by KLAS, that can drive improvements to healthcare technology and services. To the healthcare vendors who diligently seek to align with provider needs, we thank you for your unwavering determination to deliver excellence with passion. We commend your efforts to truly be Best in KLAS.”

In this recent Nextgov article, they talk about what Team IBM/Epic are doing to prepare for the massive bid:

On Wednesday, IBM and Epic raised the bar in their bidding strategy, announcing the formation of an advisory group of leading experts in large, successful EHR integrations to advise the companies on how to manage the overhaul — if they should win the contract, of course.

The advisory group’s creation was included as part of IBM and Epic’s bid package, according to Andy Maner, managing partner for IBM’s federal practice.

In a press briefing at IBM’s Washington, D.C., offices, Maner emphasized the importance of soliciting advice and insight from the group. Members of the advisory board include health care organizations, such as the American Medical Informatics Association, Duke University Health System and School of Medicine, Mercy Health, Sentara Healthcare and the Yale-New Haven Hospital.

Epic President Carl Dvorak explained the early move will also help test the performance of an Epic system on a data center and network that meets Defense Information Systems Agency guidelines for security. An IBM spokesperson told FCW that testing on the Epic system has been ongoing since November 2014.

As we noted in our last article, 2015’s going to be an exciting year for EHR as this $11+ billion EHR contract gets handed out. What do you think of Team IBM/Epic’s chances?

The percentage of hospitals with electronic health record systems increased eightfold between 2008 and 2014, according a data brief from the Office of the National Coordinator for Health IT, FierceHealthIT reports.

The report was based on an American Hospital Association survey of non-federal acute-care hospitals.

Findings

Overall, the data show 97% of hospitals in 2014 had certified EHR technology, an increase of 35% since 2011

.

Meanwhile, 75.5% of hospitals in 2014 had a basic EHR system, up from 59.4% in 2013 and 9.4% in 2008.

The report showed that in every state at least half of hospitals had adopted a basic EHR in 2014.

The states with the highest adoption rates of basic EHR systems included:

In a blog post, Matthew Swain -- a program analyst in ONC's Office of Planning, Evaluation and Analysis -- and ONC Interoperability and Exchange Portfolio Manager Erica Galvez wrote that that about 60% of hospitals in 2014 exchanged data electronically, marking a 55% increase from 2013.

However, Swain and Galvez said, "While these survey results are promising, there is plenty of room for progress." They added, "These results capture exchange activity among hospitals; however, these results do not assess exchange volume, whether the exchange is interoperable, and if information is available to providers at the point of care".

Epic Systems, the market leader in electronic health record software (EHR), recently made a quiet but potentially transformative announcement that may finally shake the healthcare industry out of its technological doldrums.

Epic said it is prepared to support the creation of a more open interoperability platform for integration with other diversified healthcare applications. This will attract substantial investment to create software that operates, hopefully seamlessly, within the Epic EHR infrastructure. Expect Epic’s competitors to follow suit, eventually opening up the marketplace of installed EHRs to third-party software developers and the efficiencies of modern, post-EHR technology ecosystem.

Epic’s critics have often denounced the company for selling a mostly closed technology, dampening hopes for the creation of an ecosystem of best-of-breed applications that work together with the EHR to automate much of the care delivery infrastructure beyond patient intake and billing. The value of such an infrastructure is extremely compelling and so the company is under enormous pressure from its customers to become more open.

An open-architecture environment, with published Application Programming Interfaces (APIs) and open standards, will improve the functionality of EHRs in myriad ways. Consider innovations such as full-service, secure, HIPAA compliant mobile care networks within and around hospitals, integrated delivery systems and ambulatory care providers. These networks would facilitate powerful point-of-care mobile automation, such as the delivery of interactive care checklists to doctors, nurses and patients; the sharing of patient medical histories to create a comprehensive care record; and automating the patient hospital discharge process with care plans developed digitally by physicians and nurses for their individual patients. These networks integrated to the data available through the EHR will also enable advanced workflow applications. Imagine providers interacting with one another and their patients in real-time, independent of care settings when care considerations and treatments get logged as part of a living patient record and, ultimately, when real-time software and cognitive analytics can aid in the development of patient care options.

The move toward open-standards, cloud-based, mobile-enabled EHR applications will be the biggest development in the healthcare software industry in many years. The passage in 2009 of the Health Information Technology for Economic and Clinical Health Act (HITECH Act) stimulated the adoption of EHRs, but these systems were largely built on older technology and struggle to incorporate the benefits of internet-based architectures, enabling cloud and mobile computing, and as such, today the EHR value proposition still remains uncertain. However, open standards for interoperability is the key to opening up the EHR infrastructure to all facets of the provider value chain.

One of Psilos’ investments, PatientSafe Solutions, developer of a smart point-of-care mobile communications network, is already working on adapting their product for to Epic’s open source standards. As the CEO of PatientSafe Solutions, Joe Condurso, recently mentioned, “All of our customers are now seeking to optimize their EHR investments through interoperability in order to liberate and activate data with mobile tools for clinicians and patients. It’s an important part of our operations today. Being able to leverage OpenEpic to interoperate and connect with the Epic allows us to deliver more capabilities for our customers to prepare for quality and value-based reimbursement.”

Open architecture EHR as the standard, rather than the exception, should set the stage for a much brighter future for participants at all levels in the healthcare arena. Let’s hope it meets its promise and makes the delivery of U.S. healthcare — not just our medical technology — the envy of the world.

Current electronic health record systems lack adequate laboratory data graphing capabilities, according to a study published in the Journal of the American Medical Informatics Association, Modern Healthcare reports.

Study Details

For the study -- which sought to determine the abilities of various EHR systems to display test results -- researchers analyzed eight EHR systems based on 11 criteria.

Of the eight EHR systems included in the study, six had been certified by the Office of the National Coordinator for Health IT, including those from:

Allscripts;

Cerner;

eClinicalWorks;

Epic;

Meditech; and

Partners Longitudinal Medical Record.

The other systems were the Department of Veterans Affairs' Computerized Patient Record System and Glassomics, an EHR prototype designed to work with Google Glass.

The study did not rate the EHR systems by name.

Findings

Overall, the researchers found none of the systems met all 11 criteria.

According to the study, the highest-rated system achieved 10 of 11 criteria, while the lowest-rated system achieved five.

The most common problem among EHR systems was the failure to label the vertical, or Y-axis.

Other flaws included:

An EHR system that labeled data in reverse order with the most recent data on left instead of the right;

An EHR system that did not equally space out data points on graphs, which could result in an erroneous slope when measuring rates; and

Three systems that did not include patient identification directly on the graphs.

According to EHR Intelligence, the results showed a lack of standardized workflows among EHR systems, which could lead to an increase in medical errors and a decline in patient safety.

Between system replacements, EHR interoperability issues, and ICD-10 implementation delays, the health IT landscape has been as complex as ever over the last year. In an effort to get the industry ready for coming challenges, Black Book Market Research conducted an inpatient EHR user survey to find out the top inpatient EHR vendors for 2015.

Black Book polled 14,000 nurses and 5,000 hospital staff using EHR technology among 702 hospitals. The survey was taken from August 2014 to February 2015. One interesting finding from the poll shows that 74 percent of hospital CIOs and medical technology leaders claimed their selection of EHR systems consisted of “significant nursing input.”

“Black Book survey findings included a substantial improvement in reducing the gap between hospital nursing, physician, administrative, financial and technology stakeholder satisfaction, although there’s still a long way to go,” Doug Brown, Managing Partner of Black Book, said in a company press release.

Out of all nurses responding, 14 percent felt that clinicians’ perspectives were considered highly when selecting healthcare technology to improve workflow and care. About one in five hospital IT managers – 19 percent – state that the current EHR system used in their practice is not the best technology to operate in their facility.

Many find that their EHR systems are not meeting the needs of their facility including their EHR interoperability goals and cost-cutting strategies through expensive add-ons. The survey also illustrated that 69 percent of hospital technology leaders feel that nursing satisfaction has risen due to EHR system updates that occurred after implementation because of nurses’ concerns.

Only 10 percent find that the improvements in nursing satisfaction is due to training and adjustment in EHR use while 20 percent of respondents attribute it to enhancements in EHR functionalities and updates.

The Black Book survey uncovered the top three EHR vendors to be CPSI, Cerner, and Allscripts. Epic Systems was right behind Allscripts among hospitals with 250 beds or more. For the past three years, Epic had earned top client bestowed honors among academic teaching facilities and large hospitals.

CPSI received a nursing and clinician satisfaction rating of 90.2 percent and a technology and financial administrative satisfaction rating of 95.4 percent. Cerner’s satisfaction rating among nurses and clinicians hit 91 percent while the technology and financial administrative satisfaction rating was at 94.1 percent.

Allscripts had its nursing and clinician satisfaction at 83.2 percent with the technology and financial administrative satisfaction hitting 92 percent. Hospital CIOs and IT managers selected Cerner as their first choice for an EHR system suitable within the hospital setting. Other vendors that scored well include Epic Systems, GE Healthcare, Meditech, McKesson, and Siemens.

In order to ensure high physician and nursing satisfaction within the healthcare system, providers will need to implement top EHR systems capable of meeting the demands of the industry and being customized to fit physician practice needs.

ActX, founded in 2012 and just out of stealth mode six months ago, collects a patient’s genetic information by way of a saliva sample, and then analyzes the information in real time. The data is integrated into an EHR – already, ActX is working with Allscripts and Greenway Health – and physicians will receive an alert about a medication and possible side effects, or warn of potentially serious risks for cancer.

Think of it as a 23andMe that is integrated into an EHR and available to the patient.

“Our goal is to try to bring precision medicine to a much larger proportion of patients,” she told MedCity News. “Right now it tends to be focused particularly on people with cancer, and even then on a low number of patients.”

She added that genomic data combined with an EHR could have “real clinical meaning for a larger number of patients than we could have known about five or 10 years ago.”

The pilot will begin in the coming weeks on 50 patients that the health system thinks will be a good fit, Coye said. Depending on initial success, it will be expanded to a greater number.

“If successful, and our physicians are enthusiastic about it, we’ll rapidly make it available more widely,” she said, adding that most UCLA Health pilots range from three-to-six months.

ActX co-founder and CEO Andrew Ury, a physician who has worked extensively in the EHR space, said up until now, few if any genomic data collectors have been integrated into an EHR. Dr. Ury previously worked for Practice Partner, which was acquired by McKesson in 2007.

As he sees it, EHR integration is the only way to harness genomic data on a large scale while at the same time providing the results for patient.

“We believe the way to do that is to build it into the everyday tool, the EHR,” he said. “The consumer factor is because we have to get the patient’s genomic data in order to make it work, so we offer access to affordable DNA sequencing. In order to that, we involve the patient.”

Given that UCLA Health uses an Epic system, which dominates the hospital market, Coye said the potential to reach a mass of patients is significant, and that such an EHR add-on could someday be a standard feature if it proves successful.

“They’re actually working with Epic, so decision support means a lot more if it pops up in the EHR,” Coye said. “This is going to be a game changer, I think. That’s the real promise that everyone recognizes about genetic testing, that this will become a standard. It’s just a question of how you do it early on.”

Importantly, Coye cited the autonomous nature of ActX in how it’s available to both patient and physician.

Dr. Ury elaborated on the potential of precision medicine and EHR integration from a clinical standpoint.

“What this means is that if a patient’s genetic data is on file, because we’ve analyzed it, each time the physician writes a prescription in the EHR, it’s going to see if a drug is going to work, or if there’s an adverse reaction,” he said. “If there is an issue, the physician will get an alert.”

The data, and its use within an EHR, can also help physicians better determine if a patient is at higher risk of a genetic disease or a certain type of cancer. With that knowledge, more effective medications and treatments can be determined far earlier than before.

Coye said UCLA Health hopes the pilot can bring precision medicine to primary care and a further breadth of specialists “across a wide variety of clinical conditions.”

ActX is so far privately funded and has about 25 employees and independent contractors, including scientists, pharmacists, genetic counselors, physicians and software developers, according to Dr. Ury.

Dr. Ury noted that it’s “the dawn of precision medicine,” referring to the $235 million initiative championed by President Obama and overseen largely by the NIH.

“While genetics can’t predict everything, genetics can predict more and more and whether a patient has a side effect,” he said. “We think this is the future.”

Stiffer competition between key vendors is causing a growing number of providers to be undecided about which EMR to purchase when looking to make a buying decision. In the KLAS acute care EMR purchasing plans report released today, researchers found that even though providers have fewer choices due to market contraction, they are less likely to have made up their minds about which system to buy when evaluating future purchases.

Energy in the market is being driven largely by legacy customers looking to make a purchasing decision. This report shines a light on which companies are under consideration by providers looking to make a decision and what is fueling that consideration.

“The competition between Epic and Cerner is closer than it has been in years past as customers determine their future purchasing plans. This has left twice as many facilities “up for grabs” as there were last year,” said report author Coray Tate. “The lion’s share of the remaining customer mindshare is split between MEDITECH and McKesson, pretty consistently along partisan lines.”

Epic Systems may be leaping to the top of yet another health IT category with a new app exchange, which would allow external developers to create products that would interface with Epic’s popular electronic health record system. The Epic App Exchange would be the health IT version of Apple or Google’s app stores, and may first try to secure entries developed by Epic customers that would enhance the openness and interoperability of the famously tight-lipped infrastructure.

“We think Epic is big now? This will cement their long-term legacy. It’s exactly the right thing to do,” said Nordic Consulting co-founder Mark Bakken in an interview with the Wisconsin State Journal. “Once they officially launch this, then it’ll be very, very easy. It will really open the floodgates for anyone that knows Epic to really get their product on the market quickly and in front of Epic’s customers. So the distribution channel is huge.”

The app store mirrors a 2013 effort by athenahealth to connect innovative services to enhance interoperability, health information exchange, and data governance for users of their products. The athenahealth Marketplace intends to bring “the best HIT solutions to the forefront,” athenahealth CEO and Chairman Jonathan Bush said at the time. “Similar to what Amazon.com is for consumers, our platform, with the immense support of our Marketplace partners, will serve as a one-stop ‘shop’ for high-value HIT solutions.”

A spokesperson from Epic confirmed the project, which Bakken says may launch within the next few weeks. The Verona, Wisconsin company has faced criticisms in the past about its closed systems as the healthcare industry embraces the notion of EHR interoperability, data standards, and widespread health information exchange.

While it has made a few nods towards industry integration, Epic has secured such dominance in the hospital market that it has been able to largely ignore the complaints, but it has several big projects on its agenda that may make it more difficult to continue down its previous path.

In addition to bidding for an $11 billion contract from the Department of Defense that will likely value interoperability and open architecture above Epic’s monolithic culture, moving into the ambulatory market will require more flexibility than it has shown in the hospital sphere.

Primary care providers interested in population health management or joining the accountable care movement need EHR infrastructures that can easily speak to products from different vendors. With the ambulatory EHR market so fragmented and the priorities of physician offices changing, Epic may need to expand its interoperability strategies if it wishes to continue its slow but steady gain in market share.

The app store might be a smart way to do this. By encouraging third parties to develop connections between Epic products and other offerings, Epic gets to take credit for promoting EHR interoperability without having to do too much of the work itself. The company will be providing interested developers with a “roadmap” about how to work with the company, Bakken says. More details will no doubt be forthcoming, but until then, the healthcare industry will have to do what it always does: wait at Epic’s gates until it decides to open up.

Epic Systems is the number one vendor when it comes to physician EHR adoption, but it only barely beats out some of its close competitors for the top spot, according to a report from SK&A. While the mega-vendor is a frequent choice for large hospitals and health systems, taking best-in-show honors from KLAS Research for nine out of the past ten years, Epic has not yet secured total dominance on the physician side. The highly fragmented market has left a number of other vendors nipping at Epic’s heels, including eClinicalworks, Allscripts, and Practice Fusion, which have secured similar shares of the top 35% of physician customers.

In contrast to last year’s report, where the top ten vendors made up 53% of the physician EHR adoption market, this year’s research shows that just eight vendors have now scooped up the same proportion of providers. Epic, now at 11.6 percent of the overall market, has grown by more than 1 percent over last year’s numbers, while eClinicalworks has stayed steady at 10.2 percent, and Allscripts follows at 8.7 percent.

The next few vendors, including Practice Fusion, NextGen, GE, and Cerner, drop off from 6.7 percent to 3.5 percent, while other companies, including athenahealth, McKesson, Greenway, and MEDITECH, hover between one and two percent of market share. Overall adoption has increased from 61 percent to 62.8 percent of all responding providers, the report shows.

Quite notably, the top twenty vendors make up less than three-quarters of the physician EHR market. Twenty-seven percent of providers are using close to 500 different products that may be proprietary, specialty-specific, or small newcomers in the industry. Providers with one to three physicians were significantly more likely to be using one of these unknowns than larger organizations, with close to 30% of these small organizations adopting a product outside of the mainstream.

The fragmentation of the EHR landscape is a boon for startup developers and smaller companies looking to cash in on the few remaining paperbound providers, or those seeking to become an unhappy organization’s choice for a replacement EHR. But it is also bad news for health IT interoperability, as small vendors who may or may not be certified by the ONC for meaningful useattestation, are built upon a wide array of proprietary technologies that do not foster data exchange.

While a 2013 survey found that small EHR vendors were more likely than larger ones to produce happy customers, likely due to better customer support and more individualized attention for training and technical glitches, these vendors may also be more likely to fold suddenly under financial pressures, leaving physician organizations in the lurch.

But financial disasters are not the provenance of small vendors alone. Epic has made more headlines than most other vendors for its role in several spectacular EHR implementation failures, though it is most frequently cited for its success in larger hospitals, and continues to expand its footprint into major health systems. The Mayo Clinic recently announced that the vendor would be replacing Mayo’s trio of EHR systems with a single, integrated platform, while Epic remains in contention for the $11 billion Department of Defense EHR modernization contract. The company’s suite of offerings, including business intelligence software, ambulatory practice management, health information exchange, and patient portals provides physician practices with an attractive toolkit to fuel expansion into the physician EHR world.

Other companies are seeking a similar crossover between the ambulatory and hospital markets as adoption reaches its saturation point. athenahealth, ranked eighth in physician EHR market share by SK&A, is moving into the hospital sphere by offering its cloud-based services to the rural and critical access hospital (CAH) market.

“Rural and CAH organizations may not receive the same attention as academic medical centers and large, clinically-integrated health systems, but they make up approximately 1/3 of the hospital market,” explained Jeremy Delinsky, Chief Technology Officer at athenahealth. “They’re also innovative, important pillars of their communities, providing tremendous value and quality at generally lower costs. These providers have been unable to afford the steep price tags of legacy software installations. Our revenue model is closely tied to that of our customers; we don’t make money unless they succeed. We think this message will gain a lot of traction in the CAH market. From there, we will have room to climb upmarket.”

EHR vendors looking to achieve a foothold in both worlds will need to tailor their offerings appropriately for customers no longer satisfied with basic data entry interfaces. While some companies tout the standardization of their user experiences as a selling point, products that will continue to gain traction in either segment of the marketplace will need to meet the specific needs of choosy providers looking to make the most of their costly EHR investments.

As most regular readers know, we don’t try to get into the rat race of breaking news on things like EHR selection, the latest meaningful use, or whatever else might be time sensitive healthcare news. Sure, every once in a while we’ll report something we haven’t seen or heard other places, but we’re more interested in the macro trends and the broader insight of what various announcements mean. We don’t want to report on something happening, but instead want to tell you why something that happened is important.

A great example of this is Mayo Clinic’s decision to go with Epic and leave behind Cerner, GE, and other systems. There’s a good interview with Mayo Clinic CEO, Cris Ross, that talks about Mayo’s decision to go with Epic. As he says in the interview, GE Centricity wasn’t part of their future plans, and so they were really deciding between Epic and Cerner. Sad to see that Vista wasn’t even part of their consideration (at least it seems).

Based on Cris Ross’ comments, he commented that he liked Epic’s revenue cycle management and patient engagement options better than Cerner. Although, my guess is that they liked Epic’s ambulatory better than Cerner as well since they were going away from GE Centricity. Cris Ross’s double speak is interesting though:

As we looked at what met our needs, across all of our practices, around revenue cycle and our interests around patient engagement and so on, although it was a difficult choice, in the end it was a pretty clear choice that Epic was a better fit.

Either it was a difficult choice or it was a pretty clear choice. I think what Cris Ross is really saying is that they’d already decided to go with Epic and so it was a clear choice for them, but I better at least throw a dog bone to Cerner and say it was a hard choice. Reminds me of the judges on the voice that have to choose between two of their artists. You know the producers told them to make it sound like it’s a hard choice even if it’s an easy one.

Turns out in Mayo’s case they probably need to act like it was a really hard choice and be kind to Cerner. Mayo has been a Cerner customer for a long time and the last thing they want to do is to anger Cerner. Cerner still holds a lot of Mayo’s data that Mayo will want to get out of the Cerner system as part of the move to Epic.

I’ll be interested to watch this transition. Will Cerner be nice and let Mayo and their EHR data go easily? Same for GE Centricity. I’ve heard of hundreds of EHR switches and many of them have a really challenging time getting their data from their previous EHR vendor. Some choose to make it expensive. Others choose to not cooperate at all. Given Mayo’s stature and the switch from Pepsi to Coke (Cerner to Epic, but I’m not sure which is Pepsi and which is Coke), I’ll be interested to see if Cerner lets them go without any issues.

I can’t recall many moves between Epic and Cerner and vice versa. Although, we can be sure that this is a preview of coming attractions. It will be interesting to see how each company handles these types of switches. What they do now will likely lay the groundwork for future EHR switching.

Everyone’s heard about it, but nobody’s seen it — the perfect EMR. You know, the one that satisfies every doctor, integrates easily with every related hospital system, plays well with HIEs and even makes coffee for the CIO.

In all seriousness, virtually every EMR installation seems to involve systems integration problems, workflow requirements, user interface design or a baker’s dozen of additional problems that hang like a cloud of smoke over even the more successful rollouts.

In theory, you might be able to resolve these disputes by letting the staff choose which EMR they’d like to see in place. But in reality, that doesn’t work either, argues John Halamka, MD, MS, whose many titles include CIO of Beth Israel Deaconess Medical Center and CIO at Harvard Medical School. “I’ve heard from GE users who want Allscripts, eClinicalWorks users who want Epic, Allscripts users who want AthenaHealth, and NextGen users who want eClinicalWorks,” he notes.

Worse, if you let every department and clinical constituency pick what they want to include in their EMR, you end up with “an unintegrated melange of different products that make care standardization impossible,” Dr. Halamka suggests.

As nice as it would be to satisfy everyone, there’s really only one approach that works, Dr. Halamka says. IT leaders need to pick an EMR for their enterprise that meets the enterprises overall strategic goals, one “providing the greatest good for the greatest number.” Then, follow up with substantial training, education, collaboration, user engagement support and healthcare information exchange, he says.

No matter what your EMR turns out to be, it’s going to fix some workflow and process issues while creating others, he suggests. The best thing healthcare CIOs can do is simply go with smart enterprise-wide technology and help providers user it effectively.

This argument makes a lot of sense to me, at least at this stage in the emergence of EMRs. In, say, five years when key features are more standardized, it might be easier to buy “off the shelf” EMRs that please almost everyone. Or will it? What do you think?

In the rapidly-evolving EHR market, one size definitely does not fit all and true EHR customization can make all the difference.

It is a commonly-held belief that the healthcare system in the United States is in need of more than a fairly steep overhaul. In fact, the once highly sought after profession of doctor has shifted to become one of the more embattled jobs nationwide.

Many healthcare professionals are now forced into the impossible situation of navigating exploitation by insurance companies and government regulations, all while grappling with the challenges of providing quality patient care, keeping their practices afloat, earning a living and paying back often-exorbitant medical school loans. If anything, in today’s world it would surprise most people to know how little doctors actually make, relative to the effort and investment in their careers they are required to put in, day in and day out.

This is a critical issue facing the US today, as tens of thousands of physicians are closing their practices every year and either retiring or becoming employees of large healthcare corporations. This is having a significant impact on accessibility and affordability of medical care. With fewer doctors available and many individuals seeking care from “corporatized” healthcare providers, not only is the personal relationship between doctor and patient lost, the cost of medical care at corporate-run medical facilities is substantially higher than ever before.

Capable and cost-effective?

So, the question becomes — how do doctors maximize their healthcare practice and record management processes, cost-efficiently and effectively? Enter the wide variety of EHR and EMR solutions that have flooded the market in recent years, each promising to streamline the process and take the guesswork out of compliance to the government’s evolving mandates that regulate healthcare record-keeping.

In addition to managing healthcare records, doctors also need a secure and HIPAA compliant scheduling system, medical devices integration, practice management system, e-prescription, lab interfaces, patient engagement, and tele-medicine. Of course, these systems must also be equipped with disaster recovery and business continuity safeguards.

And while there are many current solutions on the market which range from open source to a one-stop package that practices implement directly on their end, they miss one crucial element. Each doctor practices his/her profession in their own unique way,and this extends to all aspects of their work, from patient care to record keeping and practice management. Just as Dr. Lawrence ‘Rusty’ Hofmann in The Huffington Post,describes it, “EHRs are like Model T Ford: Any Color You Want As Long As It’s Black.” The majority of these solutions hitting the market today just don’t cut the mustard when it comes to really addressing the needs of our country’s doctors and healthcare practices.

Furthermore, while the creators of many of these packaged EHR solutions claim to be “customizable,” they are actually merely “configurable.” Instead of allowing the user the autonomy and flexibility to create a system with parameters that align with their own specific practice and its operational goals, editable functions are typically limited to creating additional fields in the forms — barely paying lip service to the task of meeting the true needs of healthcare professionals in this country.

These solutions also require heavy reliance on a computer screen, which often hinders a doctor’s ability to provide the standard of care and bedside manner that comes with more face-to-face interactions inquiring into pain, ailments, and body language from patients. This seminal aspect of the healthcare field is threatened by one-size-fits-all systems that squelch the nuances between practices and the differing techniques doctors use to treat their patients. This diversity between providers is central to continued advancements in the medical field and breakthroughs in patient care and disease treatment.

Diversity and true EHR customization rule

So then, what is the answer? In my opinion, built from countless conversations with doctors on this issue, it is EHR systems that provide an easy-to-use interface that are truly customized to fit the ways in which each doctor treats patients, approaches his/her field, and manages their practice, in a cost-effective package that does not require a huge up-front investment. Additionally, everyone within the practice should have access to the system, to ensure continuity in an often-volatile EHR market that typically sees 45-50% churn annually.

In short, it is crucial that developers of these software tools accommodate doctors’ needs first, rather than create a framework that expects doctors to squeeze themselves into a pre-defined structure, often asking them to sacrifice their individuality, professional approach, and expertise.

This approach, which represents incredible opportunity in the once thought to be saturated EHR market, is the essential step to rescuing our doctors from their often embattled position, bringing them back to the esteemed position they once held, all while improving our overall patient experiences and outcomes in the process.

Mayo Clinic announced this week that it would be abandoning its three current EHR systems in favor of a new contract with EHR giant Epic, which will now be the healthcare icon's sole EHR provider and strategic partner, according to a Mayo press release.

The plan is to deploy a single, integrated Epic EHR and revenue cycle management system at Mayo's main campus. Jilted in the deal are GE and Cerner, who were the providers of Mayo's current systems.

"With our staff working together on a common system, we will be able to accelerate innovation, enhance services and provide a better experience for our patients," said Dawn Milliner, MD, Mayo's chief medical information officer, in the release. The current schedule will see the project team assembled by April of this year, with the actual system being built between then and 2016, and a final implementation target of 2017.

Dive Insight:

If this were any other press release from almost any other provider and vendor, it would not be news. But the words "Mayo" and "Epic" make this an important milestone in an incredibly competitive race.

First, it's a game changer for the Mayo Clinic, as it will completely overhaul its existing system from scratch. Moreover, it's a bodyblow to Cerner,who we predictedhad a good shot at swiping the top spot in the EHR biz from Epic earlier this year. We'll be the first to admit this is a big win for Epic, and while it's not big enough to put Cerner down for the count, it's a good way for Epic to start the year (and not so good for Cerner).

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